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Protecting Patients When it Matters Most

From a very young age, I knew I was going to be a physician. For me, there was no other option. My calling is to care for people. 

I knew there would be sacrifices – years of schooling, time spent away from my family and friends and the exposure to human suffering and pain— but I wanted to make a difference in my community and make our world a little healthier. 

What I did not know is that amid legislative reform to reduce healthcare costs and end surprise medical bills, my colleagues and I would be vilified by insurance companies and researchers as greedy bill collectors who purposely send patients surprise bills. If I wanted to collect bills, I would have chosen a different profession.

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As an emergency physician, I know that Emergency Departments (E.D.) serve as a vital safety in our healthcare system. Now, more than ever, that safety net is in jeopardy, and I am concerned about our nation’s most vulnerable patients as policymakers duel over the best solution to eliminate surprise medical bills.

Providing care when patients need it most

Every day, people of all backgrounds come into the E.D. with varying symptoms and conditions. From a broken bone to a suspected heart attack, they come because of one reason: something is wrong. We are there to take care of them – no matter what. 

An experienced and dedicated team will deliver the highest quality of care. We will provide a shoulder to cry on, a hand to hold and a smile to brighten a day. We will be there 24 hours a day, 365 days a year. It is our ethical and legal responsibility to stabilize and treat all patients in an emergency without asking about their insurance status. This protection is crucial. Unfortunately, patients don’t have the same protection when it comes to insurance coverage because insurers are not obligated to pay for care.

A need for network adequacy and transparency

With increased frequency, I see patients delaying or declining care in fear of high out-of-pocket costs. When patients don’t receive the right care at the right time, their condition may worsen, resulting in more extensive treatment later and potentially higher medical expenses. It’s disheartening and dangerous.

Increasingly, insurers are covering less and pushing more costs onto patients through high deductible health plans, narrow provider networks and coverage denials. They are also advocating for rate-setting legislation that arbitrarily determines what doctors can be paid. Look at what is happening in California. After the state passed a law with a low benchmark payment rate, insurers are refusing to renew long-standing contracts, initiating contract terminations or demanding significant reductions in reimbursement. Without fair and reasonable reimbursement, the resources hospitals need to provide care become strained. Consequently, it will become harder to invest in clinical quality, recruit physicians and keep hospital doors open – especially in rural communities. 

A patient-centered solution

All of us – physicians, hospitals, insurance companies and legislators – have a shared stewardship to provide patients with access to quality, affordable care. As Congress reviews solutions to end surprise medical bills, it’s imperative that any bill passed incorporates an independent dispute resolution (IDR) process. 

An IDR process is an effective way to promote fair contract negotiations between insurers and providers. In states like New York, it’s been proven as a relatively easy, quick and inexpensive process. Most importantly, it’s the only solution that keeps patients out of the middle. 

The House Energy and Commerce Committee recently amended its bipartisan proposal to include a form of IDR. While it’s a step in the right direction, the IDR solution could be more comprehensive. 

Every day, patients entrust us with their lives. Not a moment goes by in which I am not aware of this, which is why Congress must pass a truly patient-centered solution that holds all stakeholders accountable and protects our nation’s safety net.   

James W. Rhee, M.D., FACMT, FACEP, FAAEM, is an emergency physician for Envision Healthcare practicing in Los Angeles County.

Healthcare Business Today is a leading online publication that covers the business of healthcare. Our stories are written from those who are entrenched in this field and helping to shape the future of this industry. Healthcare Business Today offers readers access to fresh developments in health, medicine, science, and technology as well as the latest in patient news, with an emphasis on how these developments affect our lives.

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